Cardiac arrest survivors at increased risk of neurologic and psychiatric events: JAMA

Denmark: A new study conducted by Niels Secher and team showed that when compared to patients with myocardial infarction and the general population, individuals discharged after cardiac arrest had a higher incidence of future stroke, dementia, epilepsy, depression, and anxiety, with falling rates over time. The findings of this study were published in the Journal of American Medical Association (JAMA). 

Long-term neurologic and behavioral hazards following cardiac arrest are mainly unknown. As a result, the purpose of this study was to look at the short-term and long-term risks of common neurologic events (stroke, Parkinson's disease, epilepsy, and dementia) as well as mental outcomes (depression and anxiety) in patients who had been hospitalized for cardiac arrest.

Between January 1, 1996, and December 31, 2016, 250 838 people from all Danish hospitals were enrolled in this countrywide population-based cohort research with a 21-year follow-up. All patients with a first-time diagnosis of cardiac arrest and two matched comparator cohorts were identified using Danish medical registries.

Patients with a first-time diagnosis of myocardial infarction were included in the first comparative cohort, whereas those from the general community were included in the second. The data was analyzed between November 1, 2020, and June 30, 2021. Medical registries were used to determine neurologic and mental outcomes following hospital release. Based on Cox regression analysis, 21–year hazard ratios (HRs) and 95 percent confidence intervals (CIs) were calculated, controlling for matching variables and adjusting for comorbidities and socioeconomic status.

The key findings of this study were as follows:

1. There were three categories found among the 250 838 persons involved in this study: 12 046 patients with cardiac arrest, 118 332 patients with myocardial infarction, and 120 460 people from the general population.

2. Patients with cardiac arrest exhibited an elevated incidence of ischemic and hemorrhagic stroke in the first year following discharge when compared to patients with myocardial infarction.

3. During the whole follow-up period, the rates for epilepsy were 28 per 1000 people, 73 per 1000 people for dementia, 270 per 1000 people for mood disorders including depression, and 187 per 1000 people for anxiety.

4. The prevalence of Parkinson's disease was comparable in the two cohorts.

5. The incidence of the aforementioned outcomes was greatest in the first year following cardiac arrest and subsequently gradually decreased.

6. In comparison between the cardiac arrest cohort and the general population cohort, the cardiac arrest group had a greater incidence of epilepsy, dementia, depression, and anxiety.

In conclusion, these findings point to the importance of preventative interventions and thorough monitoring of cardiac arrest survivors.

Reference:

Secher, N., Adelborg, K., Szentkúti, P., Christiansen, C. F., Granfeldt, A., Henderson, V. W., & Sørensen, H. T. (2022). Evaluation of Neurologic and Psychiatric Outcomes After Hospital Discharge Among Adult Survivors of Cardiac Arrest. In JAMA Network Open (Vol. 5, Issue 5, p. e2213546). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.13546